At that point it was decided to remove the PD catheter, give the whole area some rest, let the infections be totally cured and then put in a new catheter. I would need to go back for some time on Hemodialysis after all. Dr. Girish Narayen's experience had helped.
So, back to the operating table. The PD catheter was removed. And I was back after more than six years on what I hated the most in life - hemodialysis. Back to the needle jabs, back to the diet and fluid restrictions. But I took solace in the fact that this was a temporary phase and I would be back on PD soon.
We waited for a couple of months and then planned the re-insertion of the new PD catheter. Another surgery. Except that at the end of the surgery, the pain was unbearable. Usually, they give you a lot of pain killers and once the effect wears of, there is pain but fairly well controlled by oral pain killers. But this time, for some reason, on the way back home from hospital, the pain was so bad, I was actually crying with pain. Once we reached home, I took some strong pain killers and the pain reduced.
So, I was now back on PD. I started manual exchanges gradually. For some reason however, the efficiency of the dialysis had reduced. The amount of water that was being removed was much less than required. While this was being investigated I had to do a few sessions of hemodialysis so that I was properly dialyzed. So, I was doing both hemodialysis and PD for a while.
This was a complex problem. We did not know how to handle it. Why was the efficacy of the dialysis reduced? It was most probably due to the adhesions that had formed in the peritoneal cavity due to the large number of surgeries I had.
I had often come across the name of Dr. Georgi Abraham on the internet in the context of PD. I decided to go to Chennai to consult with him on this. We met Dr. Georgi Abraham in Chennai's Triple M hospital. Dr. Abraham seemed like a very concerned, affable person. He analyzed all the evidence and then suggested that we try Extraneal solution instead of Dianeal solution. Extraneal solution was another type of PD solution and he thought we might be able to get a better clearance with this solution.
Extraneal was not yet being used in India. But I managed to get a few bags through Harish Natarajan of Baxter. I tried Extraneal solution but this did not make any difference to the clearance. I was still unable to get enough dialysis.
We decided to go back and discuss this with Dr. Georgi Abraham.
"Mr. Kamal Shah". "Yes". "Please go in". It was my turn to see Dr. Georgi Abraham. This was a crucial meeting. We were going to ask him if we could remove the catheter and wait for a few more months. Would the adhesions clear out and would I be able to go back on PD again. This was more like a judge pronouncing his verdict. And I was really anxious. How would this meeting end? Will there be hope for the future? Or will it be back to hemo? I could take a few more sessions of hemo if there was the promise of returning to PD later. All this was running through my mind as I entered Dr. Georgi's room.
"Good evening doctor."
I settled down and explained to the good doctor how the extraneal had not worked. He listened intently. I then asked him the question.
"Can we remove this catheter and wait for a few months, maybe even a year, and then can we expect the adhesions to clear out and is there a hope that I can go back to PD?"
"No. This will not happen. The adhesions will not clear out. You will need to go back to Hemodialysis."
There it was. The verdict was out. Plain and simple. Like a dull thud.
There was not much I could say.